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Clinical Medicine > Ped 2 > Flashcards

Ped 2 Flashcards

1
Q

what is the most common reason why a baby is born prematurely

signs of this

A

sepsis from infection

cloudy or smelly amniotic fluid

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2
Q

what constitutes a pre term baby

three conditions to be manage

A

<37 weeks

sepsis, thermoregulation, RDS

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3
Q

what constitutes a term baby

four conditions to manage

A

37-42 weeks

sepsis, pneumonia, birth asphyxia, meconium aspiration

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4
Q

post term baby

two conditions to manage

A

>42 weeks

asphyxia related complications and sepsis

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5
Q

why are most others induced at 41-42 weeks

A

because the placent doesn’t function as well at this point and can injure the baby

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6
Q

what does a gestational age assessment look at

A

neuromuscular and physical maturity

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7
Q

components of neuromuscular maturity

A

posture

square window

arm recoil

popliteal angle

scarf sign

heel to ear

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8
Q

what is the most important indicator of gestational age

how accurate is it

A

posture

accurate with in one week

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9
Q

how would a preterm baby present posturally

A

full extension and no flexion

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10
Q

what is the square window

how sshould this change as the baby gets older

A

the angle between the palm and the flexor surface of the arm when the hand is flexed

the angle should decreased as gestational age increases

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11
Q

arm recoil test

how will this differ pretime to term

A

pull the arms down and se if the naturally recoil

a full term baby will naturally bring their arms back to less than 90, a preterm wont

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12
Q

poplital angle

A

try to draw leg up to the ear, a preterm baby will allow more extension of the knee

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13
Q

heel to ear

A

take both letgs to the ears without lifting the hips off the table, preterm will allow rhis

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14
Q

scarf sign

A

when the preterm babies arm is pulled across their neck they wont fight

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15
Q

what should cause an increased (bad) score on scarf test

A

obesity, chest wall edema, short humerus, shoulder girdle hypertonicity

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16
Q

what would cause a spuriously low (good) score on scarf sign

A

brachial plexus injury or general hypertonicity

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17
Q

what does the skin of an immatue baby look like

A

red, shiny, tacky

if 24028 weeks there will be venous patterns on the trunk, head, and neck

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18
Q

lanugo

what does it mean in term of prognosis

A

fine hair on the baby

more lanugo means the baby is more viable

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19
Q

how will the plantar surface of a preterm bbaby look like

A

preterm will have a more smooth foot

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20
Q

eye fusing

A

eyes fused suggested a gestational of 26 weeks

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21
Q

how will the ear look on a preterm baby

A

cartilage looks more firm on a term than a preterm baby

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22
Q

maturity of male genitalia

female

A

presence of testis, degree of descent, developemtn of rugea on the scrotum

prominence of the clitoris, develpment of labia minora/majora

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23
Q

neonate PE color

A

cyanosis of hands an feet is normal, jaundice is abnormal

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24
Q

what typically causes jaundice ina neonate

A

infection or hemolytic process

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25
Q

neotnate PE vital signs

A

HR 120-140 preterm 140-160

heart sounds split s2 normal with no murmurs

RR 40-60

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26
Q

neonate PE eyes, nose, jaw

A

eyes should be 2-3cm apart

nose flattened bridge

pierre robin small jaw

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27
Q

pierre robin

issues with transport and intubation

A

babies with no lower jaw or very small one, commonly have stridor and tongue obstruction

easiest to transport prone and hard to intubate

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28
Q

what would abnormal red reflex indicate

A

glaucoma or cataracts

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29
Q

ear tags/ear pits are possibly indicative of what

A

kidney malformation because they are formed at the same time

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30
Q

how should the ears line up in relation to the eyes

A

the eye and the ear should be on a horizontal line, if the ear is low set it can be indicative of a chromosomal problem

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31
Q

how many vessesls hould be in the umbilical cord

A

two veins and one artery

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32
Q

neonate PE thorax

A

symettry, retractions, precordial activity

contour of the abdomen and number of vessels in the cord

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33
Q

neonate PE spine and extremities

A

curvatures, dimpling, bulging, exposed spinal cord

symmetry in appearance in movement, ROM, positioning

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34
Q

acrocynanosis

A

constriction of small arterioles that leads to cyanosis in the hands

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35
Q

four reflexs to note on neonate PE

A

root

suck

moro

grasp

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36
Q

root reflex

A

stroking the cheek will cause the baby to turn their head to ward the stimulus

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37
Q

suck reflex

issues with develipment

A

when the roof of the babies mouth is touched they wil begin to suck

usually doens;t present until 32 weeks and not fully developed until 36 weeks

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38
Q

moro reflex

how long is it present

A

a loud sound will cause the baby to throw back their head, extend their arms, cry, then pull the limbs back in

lasts about 5-6 months

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39
Q

grasp reflex

how long is this present

A

stroking the palm causes the babies hand to close

5-6 months

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40
Q

mongolian spots

why is it important to document

A

skin discoloation

can be mistaken for a bruise and lead someone to think there is abuse

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41
Q

what is the most important part of a apgar score

A

the progression or lack thereof (apgar 4 to 9 is ok, 4 to 4 is worrisome)

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42
Q

IURG (intrauterine growth restricted)

two types

what does this put them at risk for

A

assymterical: head too big for their body

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43
Q

neurochemical etiology of ADHD

A

deficiency of dopamine and norepinephrine

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44
Q

what is the gender bias in ADHD

how do they present differently

A

males more than females

men more hyperactive

women more inattentive

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45
Q

four centers in the brain associated with ADHD

A

frontal cortex (attention, organization, executive function)

limbic system (emotions)

basal ganglia (inattention, impulsivity)

reticular activating system (inattention, impulsiviity, hyperactivity)

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46
Q

genetic correlation of ADHD

prevalence

A

70-80% genetic

5 %

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47
Q

ADHD symptoms

A

inattention

hyperactivity

impulsivity

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48
Q

diagnostic conditions for ADHD

A

6+ symptoms under 16, 5+ symptoms over 17

present for at least 6 months

symptoms inappropriate or disruptive

symptoms are present in two or more settings

clear evidence that the symptoms interfere with social functioning

symptoms are not better explained by another condition (anxiety, dissociative disorder, schizophrenia)

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49
Q

two symtom categories for ADHD

A

inattention or hyperactivity/impulsiveness

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50
Q

inattention ADHD symptoms

A

often fails to give close attention to details

trouble holding attention on tasks

doesn’t listen when spoken to

doesn’t follow thoruh with instruction or fails to finish tasks

trouble organizing tasks

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51
Q

hyperactive ADHD symptoms

A

fidgets a lot

leaves seat often

unable to play quietly

talks alot

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52
Q

combined presentation of ADHD vs predominantly inattentive or hyperactive

A

allows for inattentive and impulsive criteria if there are enough present for six months

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53
Q

forms for ADHD

A

vanderbitl form

conners scale

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54
Q

comorbid conditions associated with ADHD

A

any mental, emotional, behavior disorders

behavior issues

anxiety

depression

autism spectrum

tourettes

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55
Q

DDX for ADHD

A

age approproate activity

mood disorders

anxiety disorders

ASD

substance abuse

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56
Q

ADHD treatment (pre school)

A

start with behavior therapy with positive reinforcement

add stimulants if therapy is ineffective

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57
Q

ADHD treatment (school aged)

types of medication

A

start with medication plus behavior therapy

methylphenidate

amphetamine

dextroamphetamine

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58
Q

nonstimulant treatment for ADHD in school aged children

A

atomexetine (strattera)

buproprion (wellbutrin)

guanfacine

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59
Q

behavior therapy for teachers and parents to implement with ADHD kids

A

keeping a schedule

keeping distractions to a minimum

having a place for all their things (toys, books, etc)

setting small, reachable goals

rewarding positive behavior)

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60
Q

presentation vs diagnosis of symptoms in ASD

A

symptoms usually present in the first 2 years but no diagnosed until age 4

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61
Q

hallmark features of ASD

A

altered communiations/interactions with others

repetitive movements

restricted interests

all these symptoms interfere with functioning at home/school/etc

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62
Q

DSM diagnostic criteria for ASD

A

presistant social communication and social interaction deficits

restrictive, repetative behaviors behaviors

symptoms present in early development

symptoms cause clincally signifcant impairment to function

disturbances are not explained by an intellectual disability

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63
Q

etiology of ASD

A

unknown, possible genetic or enviromental factors

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64
Q

risk factors for ASD

A

down syndrome, fragile X, rett syndrome

older parents

having a sibling with ASD

low birth weight

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65
Q

specific symptoms of ASD

A

little to no eye contact

abnormal response when someone tries to get their attention

unusual tone of voice

flat affect

echolalia

extreme focus

hyper/hyposensitive to sensory input

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66
Q

who diagnoses ASD

A

general practitioner makes initial screen

specialized evaluation by psych, speech pathology, pediatricians

hearing screens or lab tests to rule out other causes

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67
Q

DDx of ASD

A

childhood psychoses

fragile X

hearing loss

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68
Q

comorbid conditions with ASD

A

ADHD

depression

anxiety

frequent diarrhea

colitis

asthma

eczema

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69
Q

treatment of ASD

A

early treatment is important

involves therapy and medication

social service programs

life style modification

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70
Q

intellectual disability involved impairment in what two areas

A

intellectual ability (IQ <75)

lack of adaptive behaviors (hard time learning but can communicate)

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71
Q

intellectual disability prevalence and gendrer bias

A

1% have it, 85% of those are mild

males affected more than females

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72
Q

etiology of intellectual disability

A

problems during pregnancy or child birth

genetic conditions

illnesses

injuries

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73
Q

preventable causes of intellectual disability

A

FAS

maternal drug use

maternal malnutrition

infection

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74
Q

T/F the etiology is intellectual disability is usually known

A

false, it is only known in 1/3 of patients

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75
Q

symptoms of ID

A

deficieits in intellectual functions (language development, reasoning, problem solving, planning, judgement)

deficits in adaptive learning (fails to become independent, limited functioning in daily activities)

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76
Q

diagnosing ID in children under 3.5

over 3

A

developmental testing

developmental testing, standardized tests, psych eval, vision and hearing test

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77
Q

specialized tests for diagnosing intellectual disability

A

genetic testing

brain imaging (micro/macrocephaly)

metabolic screen

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78
Q

comorbid conditions associated with intellectual disability

A

CP

epilepsy

ADHD

ASD

depression

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79
Q

DDx for ID

A

ASD

developmental delay

FAS

communication disorders

spoken language disorders

hearing loss

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80
Q

treatment for ID

A

speech therapy

OT/PT

special education

behavior therapy

counseling

medical therapy if needed

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81
Q

risk factors for pediatric depression

A

FHx of depression

family dysfunction

exposure to early difficulty (neglect, abuse)

low birth weight

TBI

gender dysphoria

substance abuse

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82
Q

symptoms of pediatric depression

A

depressed

decreased interest

change in appetite weight

sleep issues

psychomotor agitiation or retardation

fatigue

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83
Q

comorbid consitions for depression related to CV issues

A

diabetes

obesity

sedentary lifestyle

smoking

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84
Q

depression standardized tools for pediatrics

A

mood and feelings questionaire

beck depression inventory

child depression inventory (7-17)

reynolds adolescent depression (grades 7-12)

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85
Q

Dx of pediatric depression

A

HP

PE

mental status exam

labs (CBC, CMP, TSH, Urine)

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86
Q

DDx for pediatric depression

A

adjustment disorder with depressed mood

bipolar

sadness

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87
Q

treatment for pediatric depression

A

SSRI/SNRI (fluoxetine)

88
Q

sideffects of SSRI (pediatric depression)

A

abdominal pain

diarrhea

nausea

headache

sleep changes

cardiac events

suicidal thoughts

89
Q

T/F electroconvulsive therapy has been show to have no positive effect in treating pediatric depression

A

false

90
Q

citalopram is associated with what risk for what (used to treat depression)

A

long QT syndrome and sudden cardiac death

91
Q

clinical course for depression in children

adolescents

A

most end in 8-13 months with a 30-70% relapse

most end in 4-9 months, 90% within 2 years, 20-70% relapse

92
Q

risk factors for recurrence of pediatric depression

A

presence of residual Sx

enviromental stressors

limited social support

93
Q

what is the most common psychiatric condition across developmental stages

A

anxiety

94
Q

five types of anxiety disorders

A

generalized anxiety

social anxiety

separation anxiety

OCD

phobias

95
Q

symptoms of pediatric anxiety

A

overly tense and uptight

constant fears of safety

refusal to goto school

extreme worries about sleeping away from home

clingy

difficulty sleeping

96
Q

clincal diagnosis of pediatric anxiety

A

HP

anxiety screen (screen for anxiety related emotional disorders)

labs

97
Q

treatment for anxiety

A

therapy (cognitive behavioral therapy)

medications (SSRI)

98
Q

typical onset of OCD

A

10, but can start as early as 6

99
Q

what are the gender or racial bias of pediatric OCD

A

none in either category

100
Q

OCD cycle

A

obesseion, anxiety, compulsions, relief

101
Q

OCD defined

A

upsetting, recurrent thoughts leading to repetitive actions

feeling to urge to do repitive actions to soothe anxiety

difficulty stopping the reccurent thoughts until ritual is complete

102
Q

etiology of OCD

A

precise cause is unknown

some genetic correlation

dysregulation of serotonin

103
Q

risk factors for OCD

A

family Hx

stress

104
Q

Dx of OCD

A

SCARED screen

childrens yale-brown obsessive compulsive scale

105
Q

comorbid condition associated with OCD

A

other anxiety disorders

tic disorders

depression

ADHD

oppositional defiant disorder

106
Q

DDx for OCD

A

depression

bipolar

eating disorders

body dysmorphic disorder

hoarding disorder

107
Q

treatment for OCD

A

cognitive behavior therapy

medications (SSRIs, tricyclics)

108
Q

oppositional defiant disorder

A

ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that interfere with daily function

109
Q

PANDAs related to strep

A

some patients don’t show signs of OCD until they have a strep infection

110
Q

prevalence of ODD

gender, age, SE bias

A

up to 16%

no gender or SE bias

111
Q

biological factors associated with ODD

A

parent with ADHD, ODD, CD

parent with depression or bipolar

parent substance abuse

chemical imbalance

exposure to toxins

112
Q

psychological etiology of ODD

A

poor relationship with parents

neglectful or absent parents

difficultly forming social relationships

113
Q

social etiology of ODD

A

poverty

chaotic environment

abuse

neglect

lack of supervision

114
Q

symptoms of ODD

A

frequent temper tantrums

excessive arguing with adults

active defiance of adults

deliberate attempts to annoy upset people

frequent anger and resentment

115
Q

comorbid conditions for ODD

A

ADHD

learning disabilities

mood disorders (depression, bipolar)

anxiety

116
Q

treatment for ODD

A

therapy

medication at trating some of the more severe symptoms

treatment of comorbid conditions

117
Q

treatment for parents and care givers

A

positve reinforcement

be a good role model

pick your battles

set up age appropriate limits with consequences

maintain a life away from your kid

118
Q

how many/how long symptoms need to be present to diagnose ODD

A

>4 symptoms for >6months

119
Q

lanugo

A

thin soft hair found on newborns

120
Q

what is considered small for gestational age

large

A

10th percentile or less

90th perctile or more

121
Q

ortolani manuver

A

PE of a new born that checks for hips dysplasia

122
Q

capur succeduaneum

A

swelling of the scap of a neonate brought on by pressure of the being forced out of the vagina

123
Q

cephalohemotoma

A

traumatic subperiosteal hemotoma that occurs under the skin

124
Q

erbs palsy

A

brachial plexus injury of C5-6, makes a claw hand, related to birth trauma from shoulder dystocia

125
Q

klumpke palsy

A

paralysis of the forearm muscles

126
Q

syndactyl

A

fingers or toes that are attached to each other

127
Q

polydactyly

A

multiple fingers and toes

128
Q

meconium

A

the first newborn stool made of epithelium, hair, mucus, bile

129
Q

TORCH infections

A

Toxoplasmosis

Other (syphylis, chicken pox, parovirus)

Rubella

Cytomegalovirus

Herpes

130
Q

nenonate

A

less than 4 weeks old

131
Q

infant

A

birth to one year

132
Q

acrocyanosis

A

cyanosis of the hands and feet

133
Q

diastasis recti

A

separation of the rectus

134
Q

hypospadias

A

opening of the urethra on the dorsal surface of the glans

135
Q

fetal erythroblastosis

A

hemolytic anemia in the fetus caused by antibody incompatibility between the mother and fetus

136
Q

mongolian spots

A

flat blue grey spots that can be confused for bruises

137
Q

intrauterine growth retardation

A

a conditions where a baby does not grow to a normal size

138
Q

kerion

A

abscess from a fungal infection

139
Q

gastroschisis

A

baby’s intestines are out side of the abdominal cavity

140
Q

omphalocele

A

intestines and abdominal organs are formed out side the body

141
Q

palmar grasp: defined

A

newborn closes fingers around object placed in hand

142
Q

palmar grasp: duration

A

28 weeks gestation to 4 months

143
Q

rooting: defined

A

touch a neonates cheek, head turns towards stimulus with an open mouth

144
Q

rooting: duration

A

32 wks (incomplete gestation) or 36 wks (complete)

to 4 monts

145
Q

moro (startle) reflex: defined

A

hold the baby supine, allow a head dropof 1-2 cm. arms will abduct and elbows flex with fingers spread

follwed by adduction with flexion

146
Q

moro (startle) reflex: duration

A

28wks to 3 onths

147
Q

suckle reflex

A

new born sucks when something is placed in the mouth

14 weeks

148
Q

0-2 month milestones

gross

fine

social

language

A

gross: turns head to side

fine: clenched fist with eye contact

social: recognizes human face

language: vocalizes in play

149
Q

2-3 month milestones

gross

fine

social

language

A

gross: lifts head
fine: tracks objects past midline, opens hands
social: smiles responsively
language: vocalizes in play

150
Q

4-5 month milestone

A

gross: head steady in supported position
fine: hands together
social: shows displeasure through vocalization
language: looks for the source of sound

151
Q

6-8 month milestones

A

gross: rolls over, sits foward on arms
fine: reaching and raking
personal: responsed to own name, holds bottle
language: imitates speech and voice

152
Q

9-11 month milestones

A

gross stands while holding on

fine: passes object from hand to hand
social: feeds self, imitates waving
language: undestands no, says mama

153
Q

12-14 month milestones

A

gross: stands alone for 2 seconds
fine: bangs object together, places pellet in bottle
social: hugs dolls, uses gestures to indicate needs
language: uses one or two words with meaning

154
Q

15-17 month milestones

A

gross: stoops and recovers, walks well
fine: builds 2-3 cube tower
social: attempts to use sppon
language: waves bye, uses 4-5 words

155
Q

18-21 month milestones

A

gross: runs well, kicks ball, walks backwards
fine: scribbles, turns book pages
social: drinks from cup, uses spoon, feeds self
language: follows simple commands, has 20-50 words

156
Q

24 month milestones

A

gross: throws ball overhead, jumps
fine: turns door knobs, builds a 7 block tower
social: washes and ries hands, little spilling during feeding
language: two or three words combined, points to body parts

157
Q

36 month milestones

A

gross: stands on one foot for 2 seconds
fine: copies circle
social: takes turns, toliet trained
language: uses pronouns, gives names

158
Q

48 month milestones

A

gross: hops on one foot
fine: wiggles thumb, copies cross
social: dresses self
lanuage: knows colors, asks questions

159
Q

5 yr milestones

A

skips using alternating feet

fine: holds a pencil correctly
social: brushes teeth without help
language: easily carries convestaion, counts, does ABCs

160
Q

what is the peak time for SIDs

A

2-4 months in age, between 12am and 8 am

161
Q

SIDs demographic bias and risk factors

A

more likley among minorities and low SES

RFs: low birth weight, teen mothers, drug addiction, multiparity, FHx

162
Q

post mortem finding most consistent with SIDs

A

intraothoracic petiechiae with mild inflammation and congestion of the respiratory tract

163
Q

reccomendations to decrease SIDs risk

A

sleep on back

firm surface

no bedding or pillows

share room, not bed

don’t smoke

offer pacifier

avoid overwrapping, overheating, head coverings

encourage tummy time while awake

164
Q

failure to thrive

A

weight curve fallen by two percentile channels from previously established rate

165
Q

underlying causes of failure to thrive

A

inadequate nutrition

GI reflux

neglect

poverty

ignorance

166
Q

what is the most common chronic disease of childhood

A

dental caries

167
Q

when will primary teeth erupt

what factors can change this by one month

A

7 months

gestational age <37 weeks or birthweight <2500g increases that by one month

168
Q

positive barlow manuver

A

hip dislocation brought on by adduction of a flexed hip while pushing down on the thigh

169
Q

positive ortolani

A

dislocation of the hip by abducting the thigh that will elict a clunk or a spasm

170
Q

positve barlow, ortolani, or hip click lasting more than one month should be referred

A

true

171
Q

how will DTRs in an infant appear

A

brisk, possibly with clonus

172
Q

three most common causes of hyperbilirubinemia in infants

A

physiologic jaundice, prematurity, breastfeeding jaundice

173
Q

two causes of neonatal jaundice

A

excess production of bilirubin

decreased rate of conjugation

174
Q

conditions associated with excessive bilirubin production in neonates

A

blood group incompatibility

spherocytosis

G6PD deficiency

sepsis

175
Q

decreased conjugation of bilirubin in neonates is related to wha conditions

A

physiologic jaundice

gilbery syndrome

crigler-najar syndrome

176
Q

kernicterus

at what level of hyperbilirubinemia will this occur

what will it cause

A

a conditon where bilirubin passes the blood brain barrier

20-25 mg/dL

encephalopathy

177
Q

guidelines for phototherapy in neonatal jaundice

500-1000g

1000-1500g

1500-2500g

>2500g

A

bilirubin 12-15 mg/dL

15-18

18-20

>20

178
Q

why are newborns predisposed to jaundice due to increased bilirubin load

A

decreased life span of RBCs

increased RBC volume

small amount of internal bleeding

179
Q

why are newborns predisposed to jaundice due to immature hepatic circulation

A

decreased bilirubin uptake

decreased conjugation

180
Q

three reasons why newborns are predisposed to jaundice

A

increased bilirubin load

increase entreoheaptic recirculation

immature hepatic metabolism

181
Q

three phases of acute bilirubin encephalopathy

A

early, intermediate, advanced

182
Q

signs of early phase acute bilirubin encephalopathy

A

severe jaundice

lethargy

hypotonic

poor nursing

183
Q

signs of intermediate phase acute bilirubin encephalopathy

A

stupor

irritability

hypertonia of the neck and back

fever with high pitched cry

184
Q

at what stage of acute bilirubin encephalopathy is the damage likely reversible

A

the intermediate stage if there is a blood transfusion

185
Q

signs of advanced phase acute bilirubin encephalopathy

A

pronouced retrocollis-opisthotonos

shrill cry

no feeding

apnea

fever

stupor into coma

sz

death

186
Q

signs of kernicterus

A

cerebral palsy

auditory dysfunction

dental enamel dysplasia

paralysis of upward gaze

intellectual handicaps

187
Q

T/F most infants with kernicterus has show some sign of acute bilirubin encephalopathyq

A

true, but there are some with few clinical signs as well

188
Q

treatment for breast feeding jaundice

A

nursing as soon as possible after delivery

frequent nursing for the first few days

do no limit nursing time

189
Q

what causes breast milk jaundice in health infants

what is the treatment

A

familial tendency

active reabsorption of bilirubin

withhold breast feeding for 24 hours then resume

190
Q

T/F phototherapy bleaches the skin and makes jaundice more prominent

A

false, it makes it harder to see and makes visual assessment of jaundice unreliable

191
Q

risk factors for development of hyperbilirubinemia in infants older than 35 weeks gestation

A

predischarge TSB in the high risk zone

jaundice in the first 24 hours

blood group incompatibility

known hemolytic disease

gestational age 35-36 weeks

192
Q

factors that indicate decreased risk for jaundice after discharge

A

TSB in the low risk zone

gestational age 41 weeks

exclusive bottle feeding

black

discharge after 72 hrs

193
Q

what is the action of phototherapy for jaundice in neonates

A

to formation of lumirubin that will bind with water and does not need to conjugated to be excreted

194
Q

T/F the use of homephototherapy or sunlight exposure in the treatment of jaundice in neonates is effective

A

false, it is reserved for those with optional phototherapy needs or excluded all together as a theraputic tool (sunlight)

195
Q

what is the role of amniotic fluid

A

fetal breathing of amniotic fluid stimulates lung growth

if there isn;t enough fluid the baby gets pulmonaryt hypoplasia

196
Q

what is the function of surfactant

A

decreases surface tension

maintains functions residual capacty

197
Q

two conditions that might cause surfactant deficiency

A

prematurity

infant of a diabetic mother

198
Q

four issues that would inactivate surfactant

A

pulmonary hemorrhage

pulmonary edema

alveolar capillary leak

meconium

199
Q

pulmonary causes of respiratory distress

A

choanal atresia

transient tachypnea ofthe newborn

fluid aspiration (blood or meconium)

hyaline membrane disease

congenital pnemonia from rectal flora

200
Q

PE findings that indicate RDS

A

cyanosis on room air

RR +60

grunting

sternal and intercostal retractions

201
Q

hyperoxia challenge test

A

giving a neonate with RDS supplmental oxygen resolves cyanosis, indicative of pulmonary or noncardiovascular origin

202
Q

increased risk factors for RDS

A

prematurity

male

familial dispositon

c section

chorioamnionitis

hydrops

maternal diabetes

203
Q

decreased risk factors for RDS

A

chronic inttrauterine stress

maternal HTN

IUGR or SGA

corticosteroids

thyroid homone

tocolytic agents

204
Q

RDS chest xray

A

ground glass appearance, hazy, air bronchograms

205
Q

blood gas workup for RDS

A

high CO2, low O2

206
Q

management of RDS

A

antenatal steroids

surfactant replacement

CPAP

mechanical ventiliation

ABx

sedation

207
Q

acute or chronic hypoxia is indicative of what

A

meconium aspiration

208
Q

risks of meconium aspiration

A

air leak of ball valving (atelectasis, pneumothorax)

chemical pneumonitis

pulmonary HTN

209
Q

management of meconium aspiration

A

pulmonary toliet

umbilical lines

oxygen monitoring with mechanical ventilation

chest xray to rule out air leaks

ABx

surfactant

ECMO

210
Q

pulmonary air leaks found with meconium aspiration

A

pneumothorax

pneumomediastinum

pneumopericardium

pulmonary interstitial emphysema

211
Q

physical factors that contribute to SIDS

A

brain abnormalities

low birth weight

respiratory infeciton

212
Q

environmental contributors to SIDS

A

side or stomach sleeping

sleeping on a soft surface

cosleeping

213
Q

misc SIDS risk factors

sex

age

race

FHx

2nd hand smoke

gestational age

A

boys > girls

most vulerable during the 2nd and 3rd month

black, native american, eskimo increased risk

FHx increases risk

2nd hand smoke increases risk

preature babies have a higher risk

214
Q

maternal risk factors for SIDS

A

younger than 20

smokes

drugs or alcohol

inadequate prenatal care

215
Q

specific causes that lead to failure to thrive

A

lack of appetite (anemia, CNS issues)

difficulty swallowing

unable to get food

vomitting

malabsorption

diarrhea

inadequate absorption of calories

increased metabolism

Clinical Medicine (11 decks)

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